血管性突发性耳聋神经介入治疗的临床探讨

目的探讨神经血管介入技术对血管性突发性耳聋的疗效。方法将46例血管性突发性耳聋患者随机分为2组,动脉组22例,行脑血管造影,将微导管超选择置于小脑前下动脉,给予尿激酶30万~50万U于20~30 min注完;静脉组采用常规静脉给予扩血管、降纤药物治疗,对2组的疗效进行比较,疗效标准采用1997年中华医学会耳鼻喉科学会颁布的疗效分级。结果动脉组痊愈10例,显效6例,有效4例,无效2例;静脉组痊愈4例,显效3例,有效9例,无效8例。结论超选择局部动脉内给药可能是治疗血管性突发性耳聋的有效方法。     

超早期尿激酶静脉溶栓治疗急性脑栓塞64例疗效分析

目的观察超早期尿激酶静脉溶栓治疗急性脑栓塞的临床效果。方法选择我院收治的64例急性脑栓塞患者为研究对象,随机分为对照组和观察组。对照组采用常规治疗,观察组采用超早期尿激酶静脉溶栓治疗,比较2组治疗效果、治疗前后神经功能缺损改善情况。结果观察组总有效率达100%,显著高于对照组的62.5%。观察组治疗后24h、2周神经功能缺损评分显著优于对照组。2组不良反应发生率差异无统计学意义(P0.05)。结论超早期尿激酶静脉溶栓治疗急性脑栓塞疗效确切,安全可靠,值得临床推广应用。     

颈内动脉系统脑梗死3～6 h静脉溶栓与动脉溶栓的比较

目的 观察颈内动脉系统梗死患者3～6 h时间窗内静脉溶栓和动脉溶栓治疗的疗效.方法 对34例发病3～4.5 h和18例发病4.5～6 h颈内动脉系统梗死患者,根据头颅磁共振灌注加权成像(PWI)/弥散加权成像(DWI)≥20%,分别行静脉和动脉内超选择性重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗.治疗前后进行卒中量表(NIHSS)评分,并观察血管再通率、出血率,治疗后90 d用修正Raikin量表(MRS)评价临床预后.结果 溶栓后2组患者NIHSS评分较治疗前明显改善(P＜0.05),2组间NIHSS的改善程度差异无统计学意义(P＞0.05).治疗后90 d预后良好率:静脉溶栓组55.9%,动脉溶栓组61.1%,2组间比较差异无统计学意义(P＞0.05).血管再通率:静脉溶栓组47.1%、动脉溶栓组77.8%,2组间比较差异有统计学意义(P＜0.05).出血率:静脉溶栓组17.6%,动脉溶栓组33.3%,2组比较差异无统计学意义(P＞0.05).结论 在头颅MR PWI/DWI不匹配时,颈内动脉系统脑梗死发生3~4.5 h内静脉溶栓与4.5~6 h内动脉溶栓治疗安全有效,两者的效果相当.     

磁共振血管成像-弥散成像不匹配在尿激酶静脉溶栓治疗急性脑梗死中的应用

目的 研究磁共振血管成像-弥散成像(MRA-DWI)不匹配在尿激酶静脉溶栓治疗急性脑梗死中的临床应用价值.方法 符合溶栓标准且溶栓前行1.5 T超导磁共振(MRI)检查的36例急性脑梗死病人,根据MRI检查结果分为MRA-DWI不匹配组及MRA-DWI匹配组,给予尿激酶静脉溶栓治疗,比较2组间治疗前后神经功能缺损评分变化及不良反应的发生率.结果 溶栓治疗后第1天及第14天2组神经功能缺损评分比较差异有统计学意义(P＜0.01),溶栓治疗后第14天MRA-DWI不匹配组基本治愈率50.00%,总有效率94.44%, MRA-DWI匹配组基本治愈率5.55%,总有效率66.66%,2组比较差异有统计学意义(P＜0.05);2组溶栓后48h内不良反应的发生率(11.11%、55.56%)比较差异有统计学意义(P＜0.05). 结论磁共振血管成像-弥散成像不匹配能准确预测缺血半暗带,指导尿激酶静脉溶栓治疗急性脑梗死.     

尿激酶超早期静脉溶栓治疗急性脑梗死20例疗效观察

目的 观察应用尿激酶超早期静脉溶栓治疗急性脑梗死的有效性和安全性.方法 治疗组20例,尿激酶100万～150万 U溶于生理盐水100 mL中静滴,30 min内滴完;对照组20例给予常规治疗,分别在溶栓前、溶栓后1 d、7 d和14 d通过神经功能缺损评分评价疗效.结果 2组治疗后1 d、7 d和14 d的神经功能缺损评分比较差异有统计学意义(P＜0.05);治疗组总有效率为90%,对照组总有效率为75%,2组比较差异有统计学意义(P＜0.05);2组均无致死性出血和药物过敏反应.结论 应用尿激酶超早期静脉溶栓治疗急性脑梗死安全、有效.     

超选择动脉内接触性溶栓治疗急性脑梗死疗效分析

目的 探讨超选择动脉内接触性溶栓治疗急性脑梗死临床效果.方法 选取急性脑梗死患者88例,随机分为两组.对照组43例采用常规药物治疗.溶栓组42例采用脑血管造影后,栓塞部位尿激酶局部溶栓治疗;治疗结束后评价临床治疗效果.结果 溶栓组患者治疗总显效率、血管总再通率及Barthel指数评分完全恢复率均明显高于对照组,组间比较差异有统计学意义(P＜0.05);同时溶栓组患者治疗后美国国立卫生研究院卒中量表(NIHSS)评分明显低于对照组,组间比较差异亦有统计学意义(P＜0.05).结论 超选择动脉内接触性溶栓早期治疗急性脑梗死安全、有效,具有临床推广使用价值.     

不同方法治疗急性大脑中动脉闭塞致急性脑梗死的疗效观察

目的观察尿激酶动脉溶栓、超选择性动脉溶栓、机械结合尿激酶动脉溶栓治疗急性大脑中动脉闭塞致急性脑梗死的效果。方法选取在我院诊治的120例急性脑梗死患者,按随机数字表法随机分为A、B、C 3组,分别给予尿激酶动脉溶栓、超选择性动脉溶栓、机械结合尿激酶动脉溶栓治疗,观察分析3组临床疗效。结果 B组、C组NIHSS评分下降程度及用药安全性均明显优于A组(P0.05),B、C组间比较无明显差异(P0.05)。结论临床应用超选择性动脉溶栓、机械结合尿激酶动脉溶栓治疗急性脑梗死效果明显,可推广应用。     

甲钴胺治疗突发性耳聋的疗效观察

目的 观察甲钴胺治疗突发性耳聋的疗效.方法 突发性耳聋52例,随机分2组,每组26例.甲钴胺组采用甲钴胺治疗;对照组常规治疗.结果 2组病例治疗后耳聋症状均有改善,甲钴胺组与对照组相比较,有效率差异有统计学意义(P<0.05).结论 甲钴胺治疗突发性耳聋的疗效令人满意.     

rt-PA联合尿激酶静脉溶栓治疗急性脑梗死的疗效及安全性研究

目的观察重组组织型纤溶酶原激活剂联合尿激酶静脉溶栓治疗急性脑梗死的疗效与安全性。方法选择前循环急性脑梗死患者171例,联合溶栓组46例,单用rt-PA组39例,单用尿激酶组34例,对照组52例。观察治疗前及治疗后14d NIHSS评分,同时观察再梗死率、脑出血率及死亡率。结果 4组治疗后14d分别和治疗前比较,差异有统计学意义(P<0.05);3个溶栓组与对照组14d有效率差异有统计学意义(P<0.05);4组再发脑梗死率、死亡率差异无统计学意义(P>0.05),联合溶栓组脑出血率与单用rt-PA组及单用尿激酶组差异均有统计学意义(P<0.05)。结论 rt-PA联合尿激酶治疗急性脑梗死是安全有效的。     

重组组织型纤溶酶原激活剂动静脉联合溶栓治疗急性缺血性卒中

目的 探讨使用重组组织型纤溶酶原激活剂(rt-PA)动静脉联合溶栓治疗急性缺血性卒中的临床疗效及安全性.方法 回顾性分析104例发病在6h内急性缺血性卒中患者的临床表现、治疗方法及疗效.其中超选择性动脉溶栓 静脉溶栓组(联合组)59例,同时超选择性动脉溶栓组(动脉组)45例.动脉组用微导管超选择至病变动脉,输注rt-PA50mg;联合组先静脉输注rt-PA,再经病变动脉输注rt-PA,总量＜50mg,在溶栓前和溶栓后6h、24h、7d、30d时,采用欧洲卒中量表(ESS)评价神经功能缺损情况.结果 治疗前ESS评分,联合组为41±3,动脉组为42±10,治疗后24h、30d时,ESS评分联合组为81±23、88±25;动脉组为75±27、80±23.治疗后总再通率联合组为53%(31/59),动脉组为33%(15/45),2组比较差异有统计学意义(P＜0.05).颅内出血的发生率联合组为7%(4/59),动脉组为9%(4/45),2组比较差异无统计学意义.结论 脑梗死患者起病6h内,动静脉联合溶栓是相对安全、有效的治疗方法.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Summary of legislation of 1935 of interest to the department of Mental Hygiene

Psychiatric Quarterly -